2020年9月3日 星期四

Ractopamine

Substance
Ractopamine 

Common name or Trade name, used in 
瘦肉精 
The Joint FAO/WHO (Food and Agriculture Organization World Health) Expert Committee has set the acceptable daily intake (ADI) of ractopamine in 2006.

Ractopamine can be added in feed in the United States and Canada [1]. 

 Involving system 
- CV [2] 
- GI [2] 
- Neuro-muscular [2] 
- lifespan [3] 

 Presentation 
 - GI: nausea, vomiting. [2] 
- CV: palpitation, facial flush. [2] 
- Neuro: trunk or limb numbness, tremor, headache, weakness [2] 
- General: chill, and dyspnea [2]. 
- Promote increasing heart diseases and life expectancy reduction [3] 
- Laboratory: hypokalemia, leukocytosis, and hyperglycemia [2]. 

 Antidote and Treatment 
- intravenous hydration and potassium supplements, which gradually ameliorated their symptoms [2]. 


Disposition 
- admission: They were discharged after hospitalization for 3 (66.7%) or 4 days (33.3%) [2]. 

 - Patients’ symptoms were completely resolved within 1 week after the exposure [2]. 

-in an animal study, the cumulative risk and incidence rate of death was 75 to 90% greater in animals administered the βAA (β-adrenergic agonists) compared to contemporaneous controls [4]. 

HALF of the deaths among groups administered the βAA were attributed to the administration of the drug [4]. 

- Animal study: Postdosing 77.8% dogs developed cardiac arrhythmias and had elevated troponin levels indicating myocardial damage. Mild myocardial necrosis and fibrosis. Scattered arteries exhibited segmental medial and perimedial fibromuscular dysplasia [5]. 

 References 

 [1]. Li JH, Yu WJ, Lai YH, Ko YC. Major food safety episodes in Taiwan: implications for the necessity of international collaboration on safety assessment and management. Kaohsiung J Med Sci. 2012;28(7 Suppl):S10-S16. doi:10.1016/j.kjms.2012.05.004 

 [2]. Wu ML, Deng JF, Chen Y, Chu WL, Hung DZ, Yang CC. Late diagnosis of an outbreak of leanness-enhancing agent-related food poisoning. Am J Emerg Med. 2013;31(10):1501-1503. doi:10.1016/j.ajem.2013.07.001 

 [3]. Onishchenko GG, Popova AIu, Tutel'ian VA, et al. Vestn Ross Akad Med Nauk. 2013;(6):4-8. doi:10.15690/vramn.v68i6.666 

 [4]. Loneragan GH, Thomson DU, Scott HM. Increased mortality in groups of cattle administered the β-adrenergic agonists ractopamine hydrochloride and zilpaterol hydrochloride. PLoS One. 2014;9(3):e91177. Published 2014 Mar 12. doi:10.1371/journal.pone.0091177 

 [5]. Yaeger MJ, Mullin K, Ensley SM, Ware WA, Slavin RE. Myocardial toxicity in a group of greyhounds administered ractopamine. Vet Pathol. 2012;49(3):569-573. doi:10.1177/0300985811424752


-- Sep 3, 2020  Yu-Jang Su ~~

2020年8月4日 星期二

NPS (New Psychoactive Substances)

Substance [1, 2]

  NPS (New Psychoactive Substance).

        * so-called ‘legal highs’

* synthetic, such as designer drug.

* structural easily modified.

* difficult to detect by traditional urine test.

* novel and diverse appearance and package.

* not controlled by the 1961 Single Convention on Narcotic Drugs, or the 1971 Convention on Psychotropic Substances, posing a public threat.

 

History told by Patient (46%), Family (39%), EMT (22%), Friend (15%), Police (11%) [2]

 

 

Common name or Trade name [1, 2]

  管制一級

      Desomorphine (Krokodial) 鱷魚

  管制二級

      PCP-based. (Angel dust)

      MDPV(浴鹽)

      GHB (液態快樂丸), 神仙水

             MDMA 快樂丸、搖頭丸.

      PMMA (happy粉) 

      25B-NBOMe (毒郵票)

  管制三級

      Mephedrone (Meow Meow)喵喵

      bk-MDMA (Methylone)卡西酮

            ketamine (K仔、Special K或K)

Nimetazepam(一粒眠)

  管制四級

      5MeO DiPT (火狐狸), Tryptamine類.

 

  Mixed type (6—12種)以Ketamine為based + Cathinone, MDPV 等.混10種很常見

 

 

Involving system [1]

    * Cardiovascular: HTN, tachycardia.

* Urologic: cystitis, bladder atrophy

* GI: cramping pain

* Mental: executive dysfunction, defected memory

* Psychosis

    * addiction.

 

 

Presentation [2]

-          Respiratory rate< 10 /min, and > 16/min (88%)

-          Tachycardia + bradycardia (59%)

-          SBP >140 mmHg, <90 mmHg (32%)

-          BT (<35 degrees Celsius, > 38 degrees Celsius) 12%

-          low oxygen saturation < 90% (5%)

 

 

Antidote and Treatment [3]

-          no antidote

-          evaluation of blood morphology, coagulation parameters, biochemistry screening  

-          Symptomatic treatment of patients, fluid therapy and sedation if irritable/ aggressive behavior 

-          Management the complication, trauma, infection and so on.

 

Disposition [2]

 

  急診暫留 (52%)

Admission (16%)

ICU (14%)

Transfer (2.2%)

OHCA (0.6%)

IHCA (0.3%)

 

 

REFERENCES

 

1.      Morning meeting, July 24, 2020. Emergency Department, MacKay Memorial Hospital, Taipei, Taiwan.

 

2.      藥物濫用個案醫療救護訓練. 台灣急診醫學會. 亞東紀念醫院July 20, 2020.

 

3.      Jalali R, Dmochowska P, Godlewska I, et al. Designers Drugs-A New Challenge to Emergency Departments-An Observational Study in Poland. Medicina (Kaunas). 2020;56(7):E354. Published 2020 Jul 17. doi:10.3390/medicina56070354

 

~~ Aug 4, 2020 by Yu-Jang Su

 

 

 

 


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